US7926691B2 - Variable compression surgical fastener cartridge - Google Patents

Abstract

A surgical fastener applying apparatus having a first jaw and a second jaw. The first jaw includes a cartridge body having plurality of surgical fasteners disposed therein. The plurality of surgical fasteners include a plurality of first surgical fasteners having a first backspan with a first configuration, and a plurality of second surgical fasteners having a second backspan with a second, different configuration such that the plurality of first surgical fasteners apply a first compressive force to tissue upon formation and the plurality of second surgical fasteners apply a second, different compressive force to tissue upon formation.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent Application Ser. No. 61/044,656, filed on Apr. 14, 2008, and U.S. Provisional Patent Application Ser. No. 61/044,696, filed on Apr. 14, 2008, the entire contents of which are incorporated by reference herein.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical fastener applying apparatus. More particularly, the present disclosure relates to surgical fastener applying apparatus that include surgical fasteners that are configured to apply varying compressive forces in tissue.

2. Background of the Related Art

Many varieties of surgical fastener applying apparatus are known in the art, some of which are specifically adapted for use in various surgical procedures including, but not limited to, end-to-end anastomosis, circular end-to-end anastomosis, open gastrointestinal anastomosis, endoscopic gastrointestinal anastomosis, and transverse anastomosis. Suitable examples of apparatus which may be used during the course of these procedures can be seen in U.S. Pat. Nos. 5,915,616; 6,202,914; 5,865,361; and 5,964,394.

In general, a surgical fastener applying apparatus will include an anvil that is approximated relative to a surgical fastener cartridge during use or a fastener cartridge that is approximated relative to an anvil. The anvil includes depressions that are aligned with, and/or are in registration with slots defined in the surgical fastener cartridge, through which the fasteners will emerge. To effectuate formation, the fasteners emerge from the surgical fastener cartridge and are driven against the anvil. The surgical fastener cartridge typically has one or more rows of fasteners disposed laterally outward of a channel or knife slot that is configured to accommodate a knife, or other such cutting element, such that tissue can be simultaneously severed and joined together. Depending upon the particular surgical fastener applying apparatus, the rows of fasteners may be arranged in a linear, non-linear, e.g. circular, semi-circular, arcuate, or other configuration.

Various types of surgical fasteners are well known in the art including, but not limited to, unitary fasteners and two-part fasteners. Unitary fasteners generally include a pair of legs that are adapted to penetrate tissue and connected by a backspan from which they extend. In use, subsequent to formation, certain types of unitary fasteners have a “B” shaped configuration. Typically, the two-part fastener includes legs that are barbed and connected by a backspan. The legs are engaged and locked into a separate retainer piece that is usually located in the anvil. In use, the two-part fastener is pressed into the tissue so that the barbs penetrate the tissue and emerge from the other side where they are then locked into the retainer piece.

During each of the aformentioned surgical procedures, the tissue is initially gripped or clamped between the cartridge and anvil such that individual fasteners can be ejected from the cartridge, through the slots, and forced through the gripped tissue. Thereafter, the fasteners are formed by driving them into the depressions formed on the anvil.

A common concern in each of the procedures mentioned above is hemostasis, or the rate at which bleeding of the target tissue is stopped. It is commonly known that by increasing the amount of pressure applied to a wound, the flow of blood can be limited, thereby decreasing the time necessary to achieve hemostasis. To this end, conventional surgical fastener applying apparatus generally apply two or more rows of fasteners about the cut-line to compress the surrounding tissue in an effort to stop any bleeding and to join the cut tissue together. Each of the fasteners will generally apply a compressive force to the tissue sufficient to effectuate hemostasis. However, applying too much pressure can result in a needless reduction in blood flow to the tissue surrounding the cut-line, resulting in an elevated level of necrosis, a slower rate of healing, and/or a greater recovery period.

Consequently, it would be advantageous to provide a surgical fastener applying apparatus capable of limiting the flow of blood in the tissue immediately adjacent the cut-line to effectuate hemostasis and wound closure, while maximizing blood flow in the surrounding tissue to facilitate healing.

Additionally, when tissue is clamped and compressed between the anvil and the surgical fastener cartridge, some of the fluid of the tissue is squeezed out so the tissue is compressed further at the center portions of the cartridge and anvil than at the lateral edges, thereby leaving thicker tissue at the edges. It would therefore be advantageous to provide surgical fasteners which could better accommodate these resulting different tissue thicknesses.

SUMMARY

In one aspect of the present disclosure, a surgical fastener applying apparatus is disclosed having a first jaw and a second jaw. The first jaw includes a cartridge body having plurality of surgical fasteners disposed therein. The plurality of surgical fasteners include a plurality of first surgical fasteners having a first backspan with a first configuration, and a plurality of second surgical fasteners having a second backspan with a second, different configuration such that the plurality of first surgical fasteners apply a first compressive force to tissue upon formation and the plurality of second surgical fasteners apply a second, different compressive force to tissue upon formation.

In one embodiment, the first surgical fasteners are arranged in a first row and the second surgical fasteners are arranged in a second row laterally outward of the first row wherein the first and second backspans are configured and dimensioned such that the first compressive force is greater than the second compressive force, whereby blood flow through tissue surrounding the plurality first surgical fasteners after formation is less than blood flow through tissue surrounding the plurality of second surgical fasteners after formation.

In some embodiments, each surgical fastener in the plurality of surgical fasteners defines a substantially equivalent overall height when formed in the tissue.

In one embodiment, the first configuration of the first backspan of the plurality of first surgical fasteners include a twisted configuration defining a first height, and the second configuration of the second backspan of the plurality of second surgical fasteners include a backspan having a twisted configuration defining a second height less than the first height.

The cartridge body may include a channel that is configured to accommodate a cutting member for the creation of a cut-line in the patient's tissue. When the plurality of surgical fasteners are arranged within the cartridge body, the plurality of first surgical fasteners may be arranged to define a pair of first rows disposed laterally outwardly of the channel, and the second surgical fasteners may be arranged to define a pair of second rows disposed laterally outwardly of the pair of first rows.

In some embodiments, the plurality of surgical fasteners loaded into the cartridge body may further include a plurality of third surgical fasteners each with a third backspan having a third configuration that is different than at least one, and preferably both, of the respective first and second configurations of the first and second backspans. The third fasteners can be arranged in a third pair of rows laterally outward of the pair of second rows.

The third fasteners may be configured and dimensioned to apply a third compressive force to the tissue upon formation of the plurality of third surgical fasteners that is different than at least one, and preferably both, of the respective first and second compressive forces applied to the tissue by the first and second backspans upon formation of the plurality of first surgical fasteners and the plurality of second surgical fasteners. Preferably, the first compressive force is greater than the third compressive force, whereby blood flow through the tissue surrounding the plurality of first surgical fasteners after formation is less than blood flow through the tissue surrounding the plurality of third surgical fasteners after formation. Preferably, the third backspan is configured and dimensioned such that the second compressive force is greater than the third compressive force, whereby blood flow through the tissue surrounding the plurality of second surgical fasteners after formation is less than blood flow through the tissue surrounding the plurality of third surgical fasteners after formation.

In one embodiment, the third backspan of the plurality of third surgical fasteners may be substantially linear in configuration. Alternatively, the third backspan may have a twisted configuration which is preferably similar to the twisted backspan of the second fasteners, except defining a third height that is less than the second height defined by the second backspan of the plurality of second surgical fasteners or alternatively have an inwardly directed curve defining a third height less than second height.

In an alternative embodiment, the plurality of first surgical fasteners include first legs extending from the first backspan and terminating in penetrating ends, as well as at least one curve that is formed in the first backspan, wherein the at least one curve extends towards the penetrating ends and is dimensioned to define a first height. Additionally, or alternatively, the plurality of second surgical fasteners may include second legs extending from the second backspan and terminating in penetrating ends, as well as at least one curve that is formed in the second backspan, wherein the at least one curve extends towards the penetrating ends and is dimensioned to define a second height that is less than the first height.

In another aspect of the present disclosure, a surgical fastener cartridge is provided including a plurality of surgical fasteners disposed therein. The plurality of surgical fasteners include a plurality of first surgical fasteners arranged in a first row and having a first backspan with a first configuration, and a plurality of second surgical fasteners arranged in a second row and having a second backspan with a second configuration. The first backspan has a first height and the second backspan has a second height, the first height being less than the second height.

In one embodiment, the first and second backspans have a twisted configuration and the first fastener applies a first compressive force to tissue upon formation, and the second surgical fasteners apply a second, lesser compressive force to tissue upon formation.

In one embodiment, the first surgical fasteners include first legs extending from the first backspan and terminating in penetrating ends and the second surgical fasteners include second legs extending from the second backspan and terminating in penetrating ends, wherein the first backspan includes at least one portion curving inwardly toward the penetrating ends of the first legs to form a humped configuration and dimensioned to define a first height, and the second backspan includes at least one portion curving inwardly toward the penetrating ends of the second legs to form a humped configuration and dimensioned to define a second height different from the first height.

In preferred embodiments, the plurality of first fasteners define a pair of first rows and the plurality of second surgical fasteners define a pair of second rows disposed further from the central longitudinal axis of the cartridge than the pair of first rows.

The cartridge may include a plurality of third surgical fasteners having a third backspan with a third configuration such that the plurality of third surgical fasteners apply a third compressive force to the tissue upon formation that is different from at least one of the first compressive force and the second compressive force respectively applied to the tissue by the plurality of first surgical fasteners and the plurality of second surgical fasteners upon formation, the third fasteners being disposed further from the central longitudinal axis of the pair of first rows.

These and other features of the surgical fastener applying apparatus, surgical fastener cartridge, and surgical fasteners disclosed herein will become more readily apparent to those skilled in the art through reference to the detailed description of various embodiments of the present disclosure that follows.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present disclosure are described herein, with references to the drawings, wherein:

FIG. 1 is a top, perspective view of a distal end portion of a surgical fastener applying apparatus including a surgical fastener cartridge in accordance with one embodiment of the present disclosure;

FIG. 2 is a side, perspective view of one embodiment of a surgical fastener, including a substantially linear backspan and shown prior to formation, for use with the surgical fastener cartridge seen inFIG. 1;

FIG. 3 is a cross-sectional view of the surgical fastener shown inFIG. 2 subsequent to formation within adjacent tissue segments;

FIG. 4 is a side, perspective view of an alternative embodiment of the surgical fastener shown inFIG. 2 including a twisted backspan with a plurality of protrusions defining a first height;

FIG. 5 is a cross-sectional view of the surgical fastener shown inFIG. 4 formed within adjacent tissue segments;

FIG. 6 is a side, perspective view of another alternative embodiment of the surgical fastener shown inFIG. 2 including a twisted backspan with a plurality of protrusions defining a second, greater height;

FIG. 7 is a cross-sectional view of the surgical fastener shown inFIG. 6 formed within adjacent tissue segments;

FIG. 8 is an axial, cross-sectional view taken through line8-8 inFIG. 1, which illustrates the surgical fastener cartridge loaded with the surgical fasteners seen inFIGS. 2-5, wherein the surgical fasteners shown inFIGS. 4,5 are arranged in a pair of inner rows and the surgical fasteners shown inFIGS. 2,3 are arranged in a pair of outer rows;

FIG. 9 is a partial, longitudinal, perspective view, with parts removed, of the surgical fastener cartridge seen inFIG. 8 illustrating the plurality of surgical fasteners arranged into inner and outer rows;

FIG. 10 is a partial, longitudinal, cross-sectional view of the surgical fastener cartridge of seen inFIG. 8 taken through line10-10 inFIG. 1, which illustrates an inner and outer row of surgical fasteners;

FIG. 11 is a top, perspective view of an alternative embodiment of the surgical fastener cartridge seen inFIG. 1 loaded with a plurality of surgical fasteners arranged into inner rows, intermediate rows, and outer rows;

FIG. 12 is an axial, cross-sectional view taken through line12-12 inFIG. 11, which illustrates the surgical fastener cartridge loaded with the surgical fasteners seen inFIGS. 2-7, wherein the surgical fasteners shown inFIGS. 6,7 are arranged in the inner rows, the surgical fasteners shown inFIGS. 4,5 are arranged in the intermediate rows, and the surgical fasteners shown inFIGS. 2,3 are arranged in the outer rows;

FIG. 13 is a partial, longitudinal, perspective view, with parts removed, of the surgical fastener cartridge seen inFIG. 12 illustrating the plurality of surgical fasteners arranged into inner, intermediate, and outer rows;

FIG. 14 is a partial longitudinal, cross-sectional view of the surgical fastener cartridge ofFIG. 12 taken through line14-14 inFIG. 11, which illustrates an inner, intermediate, and outer row of surgical fasteners;

FIG. 15 illustrates an exemplary surgical fastener applying apparatus for use with the surgical fastener cartridge seen inFIG. 1 during a laparoscopic surgical procedure;

FIG. 16 is a partial, perspective view of a tool assembly of the surgical fastener applying apparatus seen inFIG. 15, with parts separated, illustrating an anvil and the surgical fastener cartridge ofFIG. 1;

FIG. 17 illustrates an end-to-end anastomosis device for use with an alternative embodiment of the surgical fastener cartridge seen inFIG. 1 during a surgical anastomosis procedure;

FIG. 18 illustrates a surgical fastener applying instrument for use with yet another alternative embodiment of the surgical fastener cartridge seen inFIG. 1 during an open gastro-intestinal anastomotic fastening procedure;

FIG. 19 illustrates a transverse anastomosis fastener applying instrument for use with an alternative embodiment of the surgical fastener cartridge shown inFIG. 18;

FIG. 20 is a top, perspective view of another alternative embodiment of the surgical fastener cartridge seen inFIG. 1 according to the principles of the present disclosure;

FIG. 21 is a side, perspective view of an alternative embodiment of the surgical fastener shown inFIG. 2 including a backspan with a plurality of recesses forming projections and defining a first height;

FIG. 22 is a cross-sectional view of the surgical fastener shownFIG. 21 formed within adjacent tissue segments;

FIG. 23 is a side, perspective view of another alternative embodiment of the surgical fastener shown inFIG. 2 including a backspan with a plurality of recesses forming projections defining a second, greater height;

FIG. 24 is a cross-sectional view of the surgical fastener shown inFIG. 23 formed within adjacent tissue segments;

FIG. 25 is a partial longitudinal, perspective view with parts removed of the surgical fastener cartridge seen inFIG. 8 loaded with a plurality of the surgical fasteners illustrated inFIGS. 2 and 21, wherein the surgical fasteners shown inFIG. 21 are arranged in a pair of inner rows and the surgical fasteners shown inFIG. 2 are arranged in a pair of outer rows;

FIG. 26 is a partial longitudinal, cross-sectional view of the surgical fastener cartridge shown inFIG. 25 taken through line10-10 inFIG. 1, which illustrates an inner and outer row of surgical fasteners;

FIG. 27 is a partial top, perspective view of the surgical fastener cartridge seen inFIG. 11 when loaded with a plurality of the surgical fasteners illustrated inFIGS. 2,21, and23, wherein the surgical fasteners shown inFIG. 23 are arranged in a pair of inner rows, the surgical fasteners shown inFIG. 21 are arranged in a pair of intermediate rows, and the surgical fasteners shown inFIG. 2 are arranged in a pair of outer rows; and

FIG. 28 is a partial longitudinal, cross-sectional view of the surgical fastener cartridge shown inFIG. 27 taken through line14-14 inFIG. 11, which illustrates an inner, intermediate, and outer row of surgical fasteners.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

Various exemplary embodiments of the presently disclosed surgical fastener applying apparatus, surgical fastener cartridge, and surgical fasteners will now be described in detail with reference to the drawings wherein like references characters identify similar or identical elements. In the drawings, and in the description which follows, the term “proximal” will refer to the end of the surgical fastener applying apparatus that is closer to the clinician during use, while the term “distal” will refer to the end that is further from the clinician, as is traditional and conventional in the art. In addition, the term “surgical fastener” should be understood to include any substantially rigid structure that is suitable for the intended purpose of joining tissue together, including but not being limited to surgical staples, clips, and the like.

FIG. 1 illustrates a distal end portion of an exemplary surgicalfastener applying apparatus1000 including asurgical fastener cartridge100 in accordance with the principles of the present disclosure. Thesurgical fastener cartridge100 extends along a longitudinal axis “A-A,” and includes acartridge body112 with a pair ofside walls114,116, abottom wall118, and atop wall120. Thetop wall120 includes a knife slot orchannel122 that is configured to accommodate longitudinal movement of a knife member123 (FIG. 16) or other cutting element such that tissue may be severed along a cut-line. Thetop wall120 further includes atissue engaging surface124 for maintaining the position of the tissue to be cut, and a plurality offastener retention slots126 that are arranged into a plurality ofrows128 that extend along the length (longitudinal axis) of thesurgical fastener cartridge100. As shown inFIG. 1, thefastener retention slots126 are arranged into a pair of first (inner)rows128_Athat are spaced laterally outward from the channel orknife slot122, on opposite sides thereof, and a pair of second (outer)rows128_Bthat are spaced laterally outward from the pair offirst rows128_A, again on opposite sides of theslot122. While thesurgical fastener cartridge100 is depicted as including pairs of first andsecond rows128_A,128_B, respectively, additional rows of fastener retention slots126 (and fasteners) may be included in alternative embodiments of thesurgical fastener cartridge100, as discussed below. In various embodiments of the present disclosure, it is envisioned that thesurgical fastener cartridge100 may be removable, or replaceable, with another loaded surgical fastener cartridge.

Each of thefastener retention slots126 is configured to receive one of a plurality of surgical fasteners, e.g., the surgical fasteners and pushers129 (FIG. 8) such that the surgical fasteners are deployed in rows, e.g. inner and outer rows in the embodiment shown inFIG. 1, on opposite sides of the cut-line created in the tissue during the surgical fastening procedure.

Further details regarding thefastener cartridge100 may be obtained through reference to U.S. Pat. No. 7,070,083, the entire contents of which are incorporated herein by reference.

Referring now toFIGS. 2 and 3 as well, thesurgical fastener cartridge100 is loaded with one or more varieties of surgical fastener, one of which may be thesurgical fastener130. Thesurgical fastener130 includes twolegs132 extending from abackspan134 extending therebetween. The thickness of thebackspan134 and thelegs132 can be varied such that thesurgical fastener130 may be used to fasten adjacent tissue segments “T₁,” “T₂” of any thickness.

Thelegs132 and thebackspan134 may define a cross-section having any suitable geometric configuration, including but not being limited to rectangular, oval, square, triangular, trapezoidal, etc. Thelegs132 and thebackspan134 may exhibit the same geometrical configuration such that the cross-sectional configuration of thesurgical fastener130 is substantially uniform, as shown inFIGS. 2,3, or alternatively, thelegs132 and thebackspan134 may exhibit different geometrical configurations, e.g., thelegs132 may exhibit a rectangular cross-sectional configuration whereas thebackspan134 may exhibit an oval cross-sectional configuration.

Prior to formation of thesurgical fastener130, thelegs132 extend from thebackspan134 such that they are substantially parallel. Alternatively, thelegs132 may converge or diverge from the backspan forming an acute or obtuse angle with the backspan. Each of thelegs132 terminates in apenetrating end136 that is configured to penetrate tissue, e.g., tissue segments “T₁,” “T₂” (FIG. 3). The penetrating ends136 oflegs132 can be tapered to facilitate the penetration of the tissue segments “T₁,” “T₂,” or alternatively, the penetrating ends136 may not include a taper. In various embodiments of thesurgical fastener130, it is also envisioned that the penetrating ends136 may alternatively define either conical or flat surfaces, as described in co-pending U.S. application Ser. No. 11/444,761, filed Apr. 13, 2003, the entire contents of which are incorporated herein by reference. Thesurgical fastener130 may also be configured as a directionally biased staple, such as that described in commonly owned U.S. Pat. No. 7,398,907, the entire contents of which are incorporated herein by reference.

In the embodiment of thesurgical fastener130 illustrated inFIGS. 2 and 3, thebackspan134 is substantially linear in configuration. When formed within tissue, e.g., within the tissue segments “T₁,” “T₂” (FIG. 3), thelegs132 of thesurgical fastener130 cooperate with the backspan134 to maintain adjacent the tissue segments “T₁,” “T₂” in approximation and apply a compressive force “F” thereto. The compressive force “F” applies pressure to the tissue segments “T₁,” “T₂,” thereby restricting the flow of blood through the tissue surrounding thesurgical fastener130 and facilitating hemostasis. The linear configuration of the backspan134 limits the amount of pressure that can be applied to the tissue segments “T₁,” “T₂,” however, such that the flow of blood through the tissue is not completely restricted. When formed, thesurgical fastener130 forms a substantially “B” shaped configuration and defines an overall height “H_F,” measured from thebackspan134 to the outermost curve of the formedlegs132.

FIGS. 4-7 illustrate alternative configurations for thesurgical fastener130 shown inFIG. 2 that will be identified generally by the reference characters130_A(FIGS. 4,5) and130_B(FIGS. 6,7). Thesurgical fastener130_Aincludes a non-lineartwisted backspan134_Adefining one ormore projections138_A, and thesurgical fastener130_Bincludes a non-lineartwisted backspan134_Bdefining one ormore projections138_B, such that thebackspans134_A,134_Bare substantially non-linear in configuration. Thesurgical fastener backspans134_Aand134_Bdiffer in configuration in that they have different heights as described in more detail below. When formed, the substantially non-linear configuration of thetwisted backspans134_A,134_Bfurther restricts the flow of blood through the tissue surrounding thesurgical fasteners134_A,134_Bupon formation when compared to the substantiallylinear backspan134 of the surgical fastener130 (FIG. 2).

Referring now toFIGS. 4,5 in particular, thebackspan134_Aof thesurgical fastener130_Aincludes twoprojections138_Adefined by the twisted configuration thereof. It should be appreciated that although the backspan has a twist that defines twoprojections138_A, it is also contemplated that further twists could be provided to defineadditional projections138_A. Theprojections138_Aextend outwardly from thebackspan134_Atowards the penetrating ends136_Aof thelegs132_A, and define a first height “H₁” that is measured from the top of theprojection138_Ato the outermost curve of thebackspan134_A. When thesurgical fastener130_Ais formed within the tissue segments “T₁,” “T₂,” theprojections138_Acooperate with thelegs132_Aof thesurgical fastener130_Ato apply a compressive force “F_A” thereto. The compressive force “F_A” applied by thesurgical fastener130_Ais greater than the compressive force “F” applied by surgical fastener130 (FIG. 3), as the compressive space140_Adefined between the backspan134_Aand thelegs132_Aand occupied by the tissue segments “T₁,” “T₂” is less in thesurgical fastener130_Awhen compared to the compressive space140 (FIG. 3) occupied by the tissue segments “T₁,” “T₂” upon formation of thesurgical fastener130. Accordingly, when compared to thesurgical fastener130, thesurgical fastener130_Aapplies greater pressure to the tissue segments “T₁,” “T₂.” Consequently, the flow of blood through the tissue surrounding thesurgical fastener130_Aupon formation will be more restricted when compared to the flow of blood through the tissue surroundingsurgical fastener130 upon formation, thereby further facilitating hemostasis. The dimensions of theprojections138_Aand the compressive space140_Aoccupied by the tissue segments “T₁,” “T₂” are such that blood flow is not completely restricted, however, thereby preventing against any unnecessary necrosing of tissue. When formed, thesurgical fastener130_Adefines an overall height “H_F” (measured from thebackspan134_Ato the outermost curve of the formed legs132_A) that is substantially equal to that defined by the surgical fastener130 (FIG. 3).

Referring now toFIGS. 6,7, thebackspan134_Bof thesurgical fastener130_Bincludes twoprojections138_Bdefined by the twisted configuration thereof. It should be appreciated that although thebackspan134_Bhas a twist that defines twoprojections138_B, it is also contemplated that further twists could be provided to defineadditional projections138_B. Theprojections138_Bextend outwardly from thebackspan134_Btowards the penetrating ends136_Bof thelegs132_Bto define a second height “H₂” that is greater than the height “H₁” of theprojections134_Aextending outwardly from thebackspan134_Aofsurgical fastener130_Aillustrated inFIGS. 4,5. Accordingly, when thesurgical fastener130_Bis formed within tissue segments “T₁,” “T₂” (FIG. 7), theprojections138_Bcooperate with thelegs132_Bof thesurgical fastener130_Bto apply a compressive force “F_B” thereto that is greater than the compressive forces “F” (FIG. 3), “F_A” (FIG. 5) respectively applied by thesurgical fasteners130,130_A, as the compressive space140_B(FIG. 7) occupied by the tissue segments “T₁,” “T₂” upon formation of thesurgical fastener130_Bis less than the compressive spaces140 (FIG. 3) and 140_A(FIG. 5) respectively occupied by the tissue segments “T₁,” “T₂” upon formation of thesurgical fasteners130,130_A. Accordingly, when compared to thesurgical fasteners130,130_A, thesurgical fastener130_Bapplies greater pressure to the tissue segments “T₁,” “T₂.” Consequently, the flow of blood through the tissue surrounding thesurgical fastener130_Bupon formation will be more restricted when compared to the flow of blood through the tissue surroundingsurgical fasteners130,130_Aupon formation. The dimensions of theprojections138_Band the compressive space140_Boccupied by the tissue segments “T₁,” “T₂” are such that blood flow is substantially, if not completely restricted, thereby further facilitating, and effectuating hemostasis. When formed, thesurgical fastener130_Bdefines an overall height “H_F” that is substantially equal to those defined by the surgical fasteners130 (FIG. 3),130_A(FIG. 5).

Thesurgical fasteners130_A,130_Bshown inFIGS. 4-7 are substantially similar but for the dimensions of the one ormore projections138_A,138_B, formed in theirrespective backspans134_A,134_B. The respective dimensions “H₁,” “H₂” of theprojections138_A,138_B, as well as the dimensions of the compressive spaces140_A,140_Boccupied by tissue segments “T₁,” “T₂” when the respectivesurgical fasteners130_A,130_Bare formed, may be altered or varied in different embodiments to effectuate any desired level of hemostasis and blood flow in the tissue segments “T₁,” “T₂” dependent upon the attributes of the tissue, e.g., the thickness thereof, or the presence of scar tissue.

FIGS. 8-10 illustrate thesurgical fasteners130,130_Ainstalled within thecartridge body112 shown inFIG. 1. Thesurgical fasteners130,130_Aare arranged within thecartridge body112 to define a pair of first (inner)rows142_Aand a pair of second (outer)rows142_Bthat correspond to the respective inner andouter rows128_A,128_Boffastener retention slots126 formed in the top wall120 (FIG. 1). Accordingly, the pair ofinner rows142_Aare spaced laterally from theknife slot122, on opposite sides thereof, and the pair ofouter rows142_Bare spaced laterally from the pair of inner rows142_A(further away from the central longitudinal axis of the cartridge), again on opposite sides of theknife slot122. As such, thesurgical fasteners130,130_Awill be deployed on opposite sides of the cut-line (not shown) created in the tissue upon fastening. That is, thesurgical fasteners130_A, which include the aforedescribed projections138_A(FIGS. 4,5), provide a greater compressive force to the tissue, since there is a shorter distance between theprojections138_Aand the curve of the formedlegs132, and accordingly, are provided in theinner rows142_Acloser to the cut-line. Thefasteners130, which define a greater distance between the curve of thelegs132 and thebackspan134 upon formation, are provided in theouter rows142_B, where the tissue might be thicker as a result of clamping the jaws of the surgical fastener applying apparatus1000 (FIG. 1).

By positioning the fasteners providing greater tissue compression closer to the cut-line, i.e., thesurgical fasteners130_Ain the embodiment of thesurgical fastener cartridge100 illustrated inFIGS. 8-10, a greater range of tissue thicknesses can be effectively sealed by a single cartridge. It should be appreciated however, that the present disclosure also envisions that the surgical fasteners can be positioned otherwise without departing from the scope of the present disclosure. Also, while the inner andouter rows142_A,142_Bare shown as including thesurgical fasteners130_A,130, respectively, the present disclosure contemplates the use of any of the surgical fasteners130 (FIGS. 2,3),130_A(FIGS. 4,5),130_B(FIGS. 6,7) disclosed herein, either exclusively, such that only a single type surgical fastener, e.g.,surgical fastener130, is present in a particular row, or in combination, such that a variety of surgical fasteners, e.g.,surgical fasteners130 and130_A, are present in the row.

As seen inFIGS. 11-14, in one embodiment, the disclosedsurgical fastener cartridge100 includes atop wall120 having a plurality offastener retention slots126 arranged into a pair of first (inner)rows128_Athat are spaced laterally outward from theknife slot122, a pair of second (intermediate)rows128_Bthat are spaced laterally outward from the pair ofinner rows128_A, and a pair of third (outer)rows128_Cthat are spaced laterally outward (further from the central longitudinal axis) from the pair ofintermediate rows128_B, each of which is spaced on opposite sides of theknife slot122. In this embodiment, the fasteners, e.g., the surgical fasteners130 (FIGS. 2,3),130_A(FIGS. 4,5),130_B(FIGS. 6,7) are respectively arranged within thecartridge body112 to define a pair of first (inner)rows142_A, a pair of second (intermediate)rows142_B, and a pair of third (outer)rows142_Cthat correspond to the respective inner, intermediate, andouter rows128_A,128_B,128_Coffastener retention slots126 formed in thetop wall120 ofsurgical fastener cartridge100. As with the embodiment of thesurgical fastener cartridge100 seen in FIGS.1 and8-10, each of the respective inner, intermediate, andouter rows142_A,142_B,142_Cmay comprise any of thesurgical fasteners130,130_A,130_Bdisclosed herein, either exclusively, such that only a single surgical fastener, e.g.,surgical fastener130, is present in a particular row, or in combination, such that a variety of surgical fasteners, e.g.,surgical fasteners130,130_A, and130_B, are present.

As illustrated inFIGS. 12-14, in one particular embodiment, theouter rows142_C, theintermediate rows142_B, and theinner rows142_Aare comprised solely of thesurgical fasteners130,130_A,130_B, respectively, such that the flow of blood through the tissue immediately surrounding the cut-line is more restricted by theinner row142_Aofsurgical fasteners130_B, whereas the flow of blood through the tissue surrounding the respective intermediate andouter rows142_B,142_Cis less restricted bysurgical fasteners130_A,130. Accordingly, the flow of blood will be minimized through the tissue immediately adjacent the cut-line, and will be increased gradually with the lateral distance from the cut-line. Also, by this arrangement, the surgical fasteners with the largest projections, e.g., thesurgical fasteners130_B, will be positioned closest to the cut-line where the tissue is generally compressed to a greater extent, and the surgical fasteners providing for less compression, e.g., thesurgical fasteners130, which include a substantiallylinear backspan134, will be positioned further from the cut-line where the tissue is generally compressed to a lesser extent. It is also contemplated that instead of a row offasteners130 with a linear backspan, a row of fasteners with a twisted backspan with a smaller height than the other twisted backspan fasteners can be utilized on the outer rows.

With reference now toFIGS. 1,15, and16, the surgicalfastener applying apparatus1000 will be discussed. The surgicalfastener applying apparatus1000 may be of either the re-usable or disposable variety, and includes ahandle assembly1002, with a movable handle1003_Aand a stationary handle1003_B, that is operatively connected to atool assembly1004 through a distally extending elongated shaft orendoscopic portion1006. In various embodiments, thehandle assembly1002 may be manually operated, and either additionally or alternatively, may include motorized, hydraulic, ratcheting, or other such mechanisms. In general, thetool assembly1004 is adapted to clamp, fasten together, and sever adjacent tissue segments along a cut-line.

Thetool assembly1004 includes asecond jaw1008 that is pivotally coupled to afirst jaw1010 to facilitate approximation thereof. Thesecond jaw1008 of thetool assembly1004 includes ananvil1100, and thefirst jaw1010 includes a surgical fastener cartridge assembly1200 incorporating the aforedescribed surgical fastener cartridge100 (FIG. 1), which is loaded with a plurality of surgical fasteners, e.g., the surgical fasteners130 (FIGS. 2,3), the surgical fastener130_A(FIGS. 4,5), and/or the surgical fastener130_B(FIGS. 6,7), (FIGS. 2,3). Pivoting the movable handle1003_Atowards the stationary handle1003_B(FIG. 1) approximates thesecond jaw1008 and thefirst jaw1010. After thejaws1008,1010 are in close operative alignment clamping tissue therebetween, continued pivoting of the movable handle1003_Aejects the plurality of surgical fasteners100 (FIG. 3) from thesurgical fastener cartridge100 such that thesurgical fasteners130,130_A,130_Bare driven into theanvil1100, thus being formed into formed surgical fasteners. Thetool assembly1004 and/or the surgical fastener cartridge assembly1200 may comprise a removable and replaceable loading unit for the surgicalfastener applying apparatus1000.

As mentioned earlier, the surgicalfastener applying apparatus1000 includes theknife member123. As seen inFIG. 16, theknife member123 is operatively connected to adrive beam1012, as described in commonly assigned U.S. Pat. No. 7,398,908, currently assigned to Tyco Healthcare Group LP, the contents of which are hereby incorporated by reference herein in its entirety. Theknife member123 may be configured and dimensioned for simultaneous engagement with both theanvil member1100 and acavity1202 that is defined by thefirst jaw1010.

During use, the tool assembly1004 (FIG. 15) is first actuated to clamp onto tissue by manipulating the movable handle1003_Ato advance a control rod (not shown) distally. Distal advancement of the control rod results in corresponding movement of the knife member123 (FIG. 16), and effectuates approximation of theanvil member1100 and the surgical fastener cartridge assembly1200. With tissue clamped between theanvil member1100 and the surgical fastener cartridge assembly1200, the fasteners, e.g., the surgical fastener130 (FIGS. 2,3), the surgical fastener130_A(FIGS. 4,5), and/or the surgical fastener130_B(FIGS. 6,7), are fired from the surgical fastener applying apparatus1000 (FIG. 1) into the tissue. The movable handle1003_Ais then operated again to further advance the knife member123 (FIG. 16).

Referring now toFIGS. 1-16, a method of fastening tissue with the surgical fastener applying apparatus1000 (FIG. 1) will be discussed. During use, the surgicalfastener applying apparatus1000 is approximated and fired similarly to, and in accordance with other known surgical fastener applying apparatus, such as that disclosed in commonly assigned U.S. Pat. No. 5,865,361, currently assigned to Tyco Healthcare Group LP, the contents of which are hereby incorporated by reference herein in its entirety.

The movable handle1003_A(FIG. 15) is operatively connected to an actuation shaft, which receives the proximal end of a control rod, such that manipulation of the movable handle1003_Aresults in linear advancement of the actuation shaft, which causes corresponding linear advancement of the control rod. An axial drive assembly is also provided that is engagable with the control rod. More specifically, the axial drive assembly includes the elongated drive beam1012 (FIG. 16), which includes a distal end that supports theknife member123, and a drive member that is configured and dimensioned for engagement with the control rod. As seen inFIG. 16, theknife member123 is positioned to translate behind asled1204.

After the surgical fastener applying apparatus1000 (FIG. 15) is manipulated to position the target tissue between theopen jaws1008,1010 of thetool assembly1004, thejaws1008,1010 are approximated using thehandle assembly1002 to clamp the target tissue therebetween and apply a compressive force thereto. Specifically, manipulation of the movable handle1003_Aadvances the actuation shaft to effectuate corresponding advancement of the control rod. Since the control rod is connected at its distal end to the drive assembly, which includes the aforementioned drive beam1012 (FIG. 16), distal movement of the control rod causes corresponding movement of thedrive beam1012, which in turn, forces theanvil1100 towards the surgical fastener cartridge assembly1200.

With the tissue securely clamped between thejaws1008,1010 (FIG. 1), the surgicalfastener applying apparatus1000 is then fired to eject the surgical fasteners, e.g., the surgical fasteners, e.g., the surgical fastener130 (FIGS. 2,3), the surgical fastener130_A(FIGS.4,5), and/or the surgical fastener130_B(FIGS. 6,7). To fire the surgical fastener applying apparatus1000 (FIG. 15), the movable handle1003_Ais again manipulated to cause advancement of the drive assembly, which causes the sled1204 (FIG. 16) to traverse thecartridge body1202, and eject the plurality ofsurgical fasteners130,130_A,130_Bfrom the surgical fastener cartridge100 (FIG. 1). More specifically, as thesled1204 moves distally, it engages the pushers129 (FIGS. 8,12,16) to thereby drive thesurgical fasteners130,130_A,130_Bupwardly, i.e., towards the top wall120 (FIG. 1) of thesurgical fastener cartridge100. As thesurgical fasteners130,130_A,130_Bare driven upwardly, thefastener retention slots126 maintain the relative positions thereof.

After passing through thefastener retention slots126, thesurgical fasteners130,130_A,130_Bpass through the tissue and are forced into engagement withpockets1102 formed in atissue contacting surface1104 of theanvil1100, thereby achieving, for example, the formed configurations seen inFIGS. 3,5, and7, respectively. Upon formation within the tissue, thesurgical fasteners130,130_A,130_Blimit the blood flow through the tissue immediately adjacent and surrounding the cut-line to thereby effectuate hemostasis, while permitting greater blood flow through the tissue spaced laterally therefrom to minimizing necrosing of the tissue, as discussed above.

While the tool cartridge has been discussed in connection with the surgicalfastener applying apparatus1000, which is adapted for use in laparoscopic procedures for performing surgical anastomotic fastening of tissue, the cartridge may be adapted for use with any surgical instrument suitable for the intended purpose of applying the plurality of surgical fasteners, e.g., thesurgical fasteners130,130_A,130_B, to a section of tissue, and thereafter, severing the tissue along a cut-line.

For example, the tool assembly1004 (FIG. 1) may be adapted for use with an end-to-end anastomosis apparatus2000 (FIG. 17), such as that disclosed in commonly assigned U.S. Pat. No. 7,455,676, currently assigned to Tyco Healthcare Group LP, the contents of which are hereby incorporated by reference herein in its entirety. Theapparatus2000 is used to simultaneously deploy a plurality of surgical fasteners arranged in substantially annular rows. A knife is advanced with the firing of the fasteners. Theapparatus200 includes ahandle assembly2002 having a pair of actuatinghandle members2004 and an approximation knob (wing nut) for moving (retracting)anvil2016 towardcartridge2012 containing the surgical fasteners.Cartridge2012 is at the distal end oftubular body portion2008 which extends fromhandle assembly2002. Ananvil shaft2014 operatively couplesanvil2016 to thehandle assembly2002 such that theanvil2016 is repositionable from a location where it is in close cooperative alignment with thefastener cartridge2012 to a location where it is spaced apart from thefastener staple cartridge2012.

Thetool assembly2010 includes a fastener ejection member that is positioned within thefastener cartridge2012. The fastener ejection member includes a distal portion defining concentric rings of peripherally spaced staple pushers that are received within a respective staple retention slot to eject the surgical fasteners from thefastener cartridge2012. The fastener ejection member is configured and dimensioned to be contacted by a distal end of a driver tube that is operatively connected to handlemembers2004 through thebody portion2008 such that manipulation effectuates advancement of the driver tube to force the staple pushers into engagement with the plurality of surgical fasteners retained with in thefastener cartridge2012 to cause ejection of the fasteners through tissue and into contact with the anvil pockets of theanvil2016, providing varying compressive forces on the tissue due to the varying configurations of the fastener.

The tool assembly1004 (FIG. 1) may also be adapted for use with a surgical stapling apparatus3000 (FIG. 18), such as that disclosed in commonly assigned U.S. Pat. No. 7,334,717, the contents of which are hereby incorporated by reference herein in its entirety. Thesurgical stapling apparatus3000 includes a cartridge receiving half-section3002, which accommodates a plurality of surgical fasteners arranged in a plurality of substantially linear rows, and an anvil half-section3004 containing a plurality of anvil pockets arranged in corresponding rows. The half-sections3002,3004 are pivotally connected viahandles3006,3008 for approximation during use.

Following approximation of the half-sections3002,3004 to clamp tissue therebetween, the surgicalfastener applying apparatus3000 is fired by advancingfiring mechanism3010 distally by the advancement of afiring knob3012. Distal movement of thefiring mechanism3010 causes a plurality of cam bars to engage camming surfaces that interact with a plurality of pushers to expel the plurality of surgical fasteners from the cartridge receiving half-section3002 through tissue into contact with the anvil pockets of theanvil portion3004, providing varying compressive forces on the tissue due to the varying configurations of the fasteners. The surgical fasteners are positioned on either side of a track which guides a knife during longitudinal movement to thereby sever tissue along a cut-line.

The tool assembly1004 (FIG. 1) may also be adapted for use with a transverse anastomosis fastening instrument4000 (FIG. 19), such as that disclosed in commonly owned U.S. Pat. Nos. 5,964,394 and 7,070,083, the contents of which are hereby incorporated by reference herein in their entirety. The surgicalfastener applying apparatus4000 includes an approximation lever4001, amovable handle4002, and anelongated portion4004 that extends distally from thehandle4002. Thecartridge200, containing a plurality of fasteners arranged in substantially linear rows transverse to a longitudinal axis of the instrument, is supported withincartridge receiving portion4014 offrame4006.

Prior to firing of the surgicalfastener applying apparatus4000, the approximation lever4001 is actuated to distally advance a drive member that is operatively connected to thesurgical fastener cartridge200 to move thesurgical fastener cartridge200 towards theanvil4012, which remains stationary, and capture tissue therebetween. Thereafter, thehandle4002 is moved to advance a pusher bar distally through theelongated portion4004 to cause corresponding movement of a head portion included at the distal end of the pusher bar. The head portion includes a plurality of fingers extending distally therefrom that are configured and dimensioned to engage the cartridge assembly to thereby eject the plurality of surgical fasteners retained therein through tissue and into contact with the anvil pockets ofanvil4012 for formation, providing varying compressive forces on the tissue due to the varying diameters. A knife can be provided in the apparatus.

It is also envisioned that the tool assembly1006 (FIG. 1) may also be adapted for use with any of the other surgical fastener applying apparatus discussed in commonly owned U.S. Pat. Nos. 6,045,560; 5,964,394; 5,894,979; 5,878,937; 5,915,616; 5,836,503; 5,865,361; 5,862,972; 5,817,109; 5,797,538; and 5,782,396, the disclosures of which are hereby incorporated by reference herein in their entirety.

In additional embodiments of the present disclosure, the surgical fastener applying apparatus may include a plurality of cam bars for interacting with the pushers to deploy the surgical fasteners. For example, the surgical fastener applying apparatus disclosed in U.S. Pat. No. 5,318,221, the disclosure of which is hereby incorporated by reference herein, in its entirety, has a cam bar adapter that holds a plurality of cam bars and a knife. A channel is advanced through operation of the handle of the apparatus, which drives the cam bars and knife forward. A clamp tube that surrounds the proximal end of the anvil is advanced to clamp the anvil and cartridge together. In another example, the surgical fastener applying apparatus disclosed in U.S. Pat. No. 5,782,396, the disclosure of which is hereby incorporated by reference herein, in its entirety, has an actuation sled. An elongated drive beam is advanced distally through operation of the handle of the apparatus, driving the actuation sled forward. The distal end of the drive beam engages the anvil and the channel that supports the cartridge as the drive beam travels distally, to deploy the staples and clamp the anvil and cartridge together.

Referring now toFIG. 20, an alternative embodiment of the surgical fastener cartridge, identified generally by thereference character200, will be discussed. Thesurgical fastener cartridge200 is substantially similar to thesurgical fastener cartridge100 discussed above, and accordingly, will only be discussed with respect to its differences therefrom.

Thesurgical fastener cartridge200 is loaded with a plurality of surgical fasteners that are arranged into one or more rows, as in the case of the aforedescribedsurgical fastener cartridge100. However, in contrast to thesurgical fastener cartridge100, thesurgical fastener cartridge200 does not include a knife slot for the accommodation of a knife or other such cutting element, although an alternative embodiment including a knife slot would be within the scope of the present disclosure. Thesurgical fastener cartridge200 includes a plurality offastener retention slots226 on atop wall220 of acartridge body212 that are arranged into a plurality ofrows228. Therows228 ofretention slots226 are spaced laterally from acenterline252 extending along the longitudinal axis “A-A” defined bycartridge body212, and may be positioned equidistant from thesidewalls214,216. As shown, the plurality ofrows228 includes a pair of first (inner)rows228_Athat are disposed on opposite sides of thecenterline252, and a pair of second (outer)rows228_Bthat are spaced laterally outward from the pair ofinner rows228_A, (further from the central longitudinal axis of the cartridge), again on opposite sides of thecenterline252. Each of thefastener retention slots226 is configured and dimensioned to receive one of a plurality of surgical fasteners, e.g., the surgical fasteners130 (FIGS. 2,3),130_A(FIGS. 4,5), or130_B(FIGS. 6,7) and pushers129 (FIG. 8) therein such that the surgical fasteners are deployed in rows, e.g., inner and outer rows in the embodiment of thesurgical fastener cartridge200 shown ofFIG. 20, on opposite sides of thecenterline252.

Although thesurgical fastener cartridge200 is depicted as including pairs of first andsecond rows228_A,228_B, respectively, additional rows offastener retention slots226, and accordingly, additional rows of surgical fasteners, may be included in alternative embodiments of thesurgical fastener cartridge200, as discussed above with respect tosurgical fastener cartridge100. Also, it is envisioned that the fasteners may be arranged within thesurgical fastener cartridge200 in any of the various exemplary configurations discussed above with respect to thesurgical fastener cartridge100, for example.

Reference will now be made toFIGS. 21-24, which illustrate alternative configurations for thesurgical fastener130 shown inFIG. 2 that will be identified generally by the reference characters130_C(FIGS. 21,22) and130_D(FIGS. 23,24), that may be loaded into thesurgical fastener cartridge100 shown inFIGS. 1,8, for example and used with the various apparatus described herein. Thesurgical fastener130_Cincludes anon-linear backspan134_Cwith one ormore recesses138_Cformed therein. Therecesses138_Cform curved portions extending inwardly from thebackspan134_C, i.e., towards the penetrating ends136_Cin the unformed condition, in arcuate fashion to define one or more humps having a first height “H₁” that act to restrict the flow of blood through the tissue surrounding thesurgical fastener130_C. As shown, in the formed condition of the fastener, the backspan preferably has a first curved portion opposite the curve of one of the legs and a second curved portion opposite the curve of the other fastener leg.

When thesurgical fastener130_Cis formed within tissue segments “T₁,” “T₂,” as seen inFIG. 22 for example, the curves (humps)138_Ccooperate with thelegs132 of thesurgical fastener130_Cto apply a compressive force “F_C” thereto. The compressive force “F_C” applied by thesurgical fastener130_Cis greater than the compressive force “F” applied by surgical fastener130 (FIG. 3), as the compressive space140_C, which is defined between the backspan134_Cand thelegs132_Cand occupied by the tissue segments “T₁,” “T₂,” is less in thesurgical fastener130_Cwhen compared to the compressive space140 (FIG. 3) occupied by the tissue segments “T₁,” “T₂” in thesurgical fastener130. Accordingly, greater pressure is applied to the tissue segments “T₁,” “T₂” bysurgical fastener130_C. Consequently, the flow of blood through the tissue surrounding thesurgical fastener130_Cis more restricted when compared to the flow of blood through the tissue surrounding surgical fastener130 (FIG. 3), thereby further facilitating hemostasis. The dimensions of the recesses/curves138_Cand the compressive space140_Coccupied by the tissue segments “T₁,” “T₂” are such that blood flow is not completely restricted, however, thereby preventing any unnecessary necrosing of tissue. When formed, thesurgical fastener130_Cdefines an overall height “H_F” (measured from thebackspan134_Cto the outermost curved of the formed legs132_C) that is substantially equal to that defined by the surgical fastener130 (FIG. 3).

With particular reference toFIGS. 23 and 24, an alternative embodiment of the surgical fastener, identified generally by thereference character130_D, is shown in its formed condition. Thesurgical fastener130_Dis similar to thesurgical fastener130_Cdiscussed above with respect toFIGS. 21 and 22, in that thesurgical fastener130_Dincludes a pair of recesses/curves138_Dformed in thebackspan134_Ddefining a pair of humps or curves. However, the recesses/curves138_Dformed in thebackspan134_Dof thesurgical fastener130_Ddefine a height “H₂” that is greater than the height “H₁” of the humps or recesses138_Cformed in thebackspan134_Cof thesurgical fastener130_Cillustrated inFIGS. 21 and 22. Accordingly, when thesurgical fastener130_Dis formed within tissue segments “T₁,” “T₂,” the recesses/curves138_Dcooperate with thelegs132_Dof thesurgical fastener130_Dto apply a compressive force “F_D” thereto. The compressive force “F_D” applied by thesurgical fastener130_Dis greater than the compressive forces “F,” “F_C” respectively applied by the surgical fasteners130 (FIG. 2,3),130_C(FIGS. 21,22), as the compressive space140_Doccupied by the tissue segments “T₁,” “T₂” is less in thesurgical fastener130_Dwhen compared to the compressive spaces140 (FIG. 3),140_C(FIG. 22) respectively occupied by the tissue segments “T₁,” “T₂” in thesurgical fasteners130,130_C. Accordingly, greater pressure is applied to the tissue segments “T₁,” “T₂” by thesurgical fastener130_D. Consequently, the flow of blood through the tissue surrounding thesurgical fastener130_Dis more restricted when compared to the flow of blood through the tissue surrounding surgical fasteners130 (FIG. 3),130_C(FIGS. 21,22). The dimensions of the recesses/curves138_Dand the compressive space140_Doccupied by the tissue segments “T₁,” “T₂” are such that blood flow is substantially, if not completely restricted, thereby further facilitating, and effectuating hemostasis. When formed, thesurgical fastener130_Ddefines an overall height “H_F” that is substantially equal to those defined by the surgical fasteners130 (FIG. 3),130_C(FIG. 22).

The surgical fasteners130_C(FIG. 21,22),130_D(FIGS. 23,24) are substantially similar in configuration but for the dimensions of the hump(s) (curves) formed by therecesses138_C,138_Dformed in theirrespective backspans134_C,134_D. The respective dimensions “H₁,” “H₂” of the recesses/curves138_C,138_D, as well as the dimensions of the compressive spaces140_C,140_Doccupied by tissue segments “T₁,” “T₂” when the respectivesurgical fasteners130_C,130_Dare in their formed conditions, may be altered or varied in different embodiments to effectuate a desired level of hemostasis and blood flow in the tissue segments “T₁,” “T₂” dependent upon various attributes of the tissue, e.g., thickness or the presence of scar tissue.

FIGS. 25 and 26 illustrate the surgical fasteners130 (FIG. 3) and 130_C(FIGS. 21,22) installed within thecartridge body112 seen inFIG. 1. Thesurgical fasteners130_C,130 are arranged within thecartridge body112 to define a pair of first (inner)rows142_Aand a pair of second (outer)rows142_Bthat correspond to the respective inner andouter rows128_A,128_Boffastener retention slots126 formed in the top wall120 (FIG. 1). Accordingly, the pair ofinner rows142_Ais spaced laterally outward from theknife slot122, on opposite sides thereof, and the pair ofouter rows142_Bare spaced laterally outward from the pair ofinner rows142_A, again on opposite sides of theknife slot122 and further from a central longitudinal axis of the cartridge. As such, thesurgical fasteners130,130_Cwill be deployed on opposite sides of the cut-line (not shown) created in the tissue upon fastening. That is, thesurgical fasteners130_C, which include the aforedescribed projections or curves138_C(FIGS. 20,21), provide a greater compressive force to the tissue, since there is a shorter distance between theprojections138_Cand the curve of the formedlegs132, and accordingly, are provided in theinner rows142_Acloser to the cut-line. Thefasteners130, which define a greater distance between the curve of thelegs132 and thebackspan134 upon formation, are provided in theouter rows142_B, where the tissue might be thicker as a result of clamping the jaws of the apparatus, e.g. the surgical fastener applying apparatus1000 (FIG. 1).

By positioning the fasteners providing greater tissue compression closer to the cut-line, i.e., thesurgical fasteners130_Cin the embodiment of thesurgical fastener cartridge100 illustrated inFIGS. 24 and 25, a greater range of tissue thicknesses can be effectively sealed by a single surgical fastener cartridge. It should be appreciated however, that the present disclosure also envisions that the surgical fasteners can be positioned otherwise without departing from the scope of the present disclosure. Also, while the inner andouter rows142_A,142_Bare shown as including thesurgical fasteners130_C,130, respectively, the present disclosure contemplates the use of any of the surgical fasteners130 (FIGS. 2,3),130_A(FIGS. 4,5),130_B(FIGS. 6,7),130_C(FIGS. 20,21),130_C(FIGS. 22,23) disclosed herein above, either exclusively, such that only a single type surgical fastener, e.g.,surgical fastener130, is present in a particular row, or in combination, such that a variety of surgical fasteners, e.g.,surgical fasteners130 and130_C, are present.

FIGS. 27 and 28 illustrate another embodiment of the present disclosure in which thecartridge body112, shown inFIG. 1, may be loaded with the surgical fasteners130 (FIG. 3),130_C(FIGS. 21,22), and130_D(FIGS. 23,24). In this embodiment, as with the embodiment seen in FIGS.1 and11-14 and discussed above, the disclosedsurgical fastener cartridge100 includes atop wall120 having a plurality offastener retention slots126 arranged into a pair of first (inner) rows that are spaced laterally from theknife slot122, a pair of second (intermediate) rows that are spaced laterally from the pair of inner rows, and a pair of third (outer) rows that are spaced laterally from the pair of intermediate rows, each of which is spaced on opposite sides of theknife slot122. Accordingly, the fasteners, e.g.,surgical fasteners130,130_C,130_Dare arranged within thecartridge body112 to define a pair of first (inner)rows142_A, a pair of second (intermediate)rows142_B, and a pair of third (outer)rows142_Cthat correspond to the respective inner, intermediate, andouter rows128_A,128_B,128_Coffastener retention slots126 formed in thetop wall120 ofsurgical fastener cartridge100. In this embodiment, as with the embodiment of FIGS.1 and11-14, each of the respective inner, intermediate, andouter rows142_A,142_B,142_Cmay comprise any of thesurgical fasteners130,130_C,130_Ddisclosed herein, either exclusively, such that only a single type surgical fastener, e.g.,surgical fastener130, is present in a particular row, or in combination, such that a variety of surgical fasteners, e.g.,surgical fasteners130,130_C, and130_D, are present. In the particular embodiment shown inFIGS. 27 and 28, however, the respective outer, intermediate, andinner rows142_C,142_B, and142_Aare comprised solely of thesurgical fasteners130,130_C,130_B, such that the flow of blood through the tissue immediately surrounding the cut-line is more restricted by theinner row142_Aofsurgical fasteners130_D, whereas the flow of blood through the tissue surrounding the respective intermediate andouter rows142_B,142_C, respectively, is less restricted by thesurgical fasteners130_C,130, respectively. Accordingly, the flow of blood will be minimized in the tissue immediately adjacent the cut-line, and will be increased gradually with the lateral distance from the cut-line. Also, by this arrangement, the surgical fasteners with the largest curved portions/recesses, e.g., thesurgical fasteners130_D, will be positioned closest to the cut-line where the tissue is generally compressed to a greater extent, and the surgical fasteners providing for less compression, e.g., thesurgical fasteners130, which include a substantiallylinear backspan134, as described above, will be positioned further from the cut-line where the tissue is generally compressed to a lesser extent.

The above description, disclosure, and figures should not be construed as limiting, but merely as exemplary of particular embodiments. It is to be understood, therefore, that the disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. Additionally, those skilled in the art will appreciate that the elements and features illustrated or described in connection with one embodiment can be combined with those of another, and that such modifications and variations are also intended to be included within the scope of the present disclosure.

Claims (21)

1. A surgical fastener applying apparatus comprising a first jaw and a second jaw, the first jaw including a cartridge body having a plurality of surgical fasteners disposed therein, the plurality of surgical fasteners including a plurality of first surgical fasteners having a first backspan with a first configuration, and a plurality of second surgical fasteners having a second backspan with a second configuration, wherein the first configuration is different than the second configuration such that the plurality of first surgical fasteners apply a first compressive force to tissue upon formation, and the plurality of second surgical fasteners apply a second, different compressive force to tissue upon formation;

wherein the plurality of first surgical fasteners are arranged in a first row, and the plurality of second surgical fasteners are arranged in a second row laterally outward of the first row, and the first and second backspans of the first and second fasteners are configured and dimensioned such that the first compressive force is greater than the second compressive force, and the backspan of the plurality of first surgical fasteners has a twisted configuration defining a first height, and the backspan of the plurality of second surgical fasteners has a twisted configuration defining a second height, the first height being greater than the second height.

2. The surgical fastener applying apparatus ofclaim 1, wherein the cartridge body includes a channel configured to accommodate a cutting member for the creation of a cut-line in the tissue.

3. The surgical fastener applying apparatus ofclaim 1, further comprising a plurality of third fasteners arranged in a third row laterally outward of the plurality of second fasteners arranged in the second row, the third fasteners having a third backspan with a third configuration different than at least one of the respective first and second configurations of the first and second backspans.

4. The surgical fastener applying apparatus ofclaim 3, wherein the third configuration is different than both of the respective first and second configurations of the first and second backspans, the third fasteners applying a third compressive force to the tissue upon formation, the third compressive force being less than the first compressive force and less than the second compressive force.

5. The surgical fastener applying apparatus ofclaim 3, wherein the third backspan of the plurality of third surgical fasteners is substantially linear in configuration.

6. The surgical fastener applying apparatus ofclaim 1, wherein the backspan includes multiple twists such that at least two portions of the backspan extend toward penetrating ends of the legs.

7. The surgical fastener applying apparatus ofclaim 1, wherein the first surgical fasteners and the second surgical fasteners define a substantially equivalent overall height when formed.

8. The surgical fastener applying apparatus ofclaim 1, wherein the first surgical fasteners include legs extending from the first backspan and terminating in penetrating ends, the first backspan including at least one first curve extending towards the penetrating ends and dimensioned to define a first height.

9. The surgical fastener applying apparatus ofclaim 8, wherein the second surgical fasteners include legs extending from the second backspan and terminating in penetrating ends, the second backspan including at least one curve extending towards the penetrating ends and dimensioned to define a second height less than the first height.

10. The surgical fastener applying apparatus ofclaim 9, further comprising a plurality of third surgical fasteners having legs extending from a third backspan and terminating in penetrating ends, the third backspan dimensioned to define a third height, the third height being less than the second height.

11. The surgical fastener applying apparatus ofclaim 9, wherein the first backspan and the second backspan have a curve positioned opposite the curve of each of the legs in a formed condition of the fastener.

12. The surgical fastener applying apparatus ofclaim 1, wherein the first and second rows are substantially linear.

13. The surgical fastener applying apparatus ofclaim 1, wherein the first and second rows are substantially annular.

14. The surgical fastener applying apparatus ofclaim 1, wherein the first and second jaws are pivotally attached.

15. The surgical fastener applying apparatus ofclaim 1, wherein at least one of the first and second jaws are movable in a substantially linear direction to move the jaws to an approximated position to clamp tissue therebetween.

16. A surgical fastener applying apparatus comprising a first jaw and a second jaw, the first jaw including a cartridge body having a plurality of surgical fasteners disposed therein, the plurality of surgical fasteners including a plurality of first surgical fasteners having a first backspan with a first configuration, and a plurality of second surgical fasteners having a second backspan with a second configuration, wherein the first configuration is different than the second configuration such that the plurality of first surgical fasteners apply a first compressive force to tissue upon formation, and the plurality of second surgical fasteners apply a second, different compressive force to tissue upon formation, wherein the plurality of first surgical fasteners are arranged in a first row, and the plurality of second surgical fasteners are arranged in a second row laterally outward of the first row, and the first and second backspans of the first and second fasteners are configured and dimensioned such that the first compressive force is greater than the second compressive force, and a plurality of third fasteners arranged in a third row laterally outward of the plurality of second fasteners arranged in the second row, the third fasteners having a third backspan with a third configuration different than at least one of the respective first and second configurations of the first and second backspans, a third backspan having a twisted configuration defining a third height less than a first height of the first backspan.

17. A surgical fastener cartridge comprising a cartridge body including a plurality of surgical fasteners disposed therein, the plurality of surgical fasteners including a plurality of first surgical fasteners arranged in a first row and having a first backspan with a first configuration, and a plurality of second surgical fasteners arranged in a second row and having a second backspan with a second configuration, wherein the first backspan has a first height and the second backspan has a second height, the first height being less than the second height;

wherein the first and second backspans have a twisted configuration and the first surgical fasteners apply a first compressive force to tissue upon formation, and the second surgical fasteners apply a second, lesser compressive force to tissue upon formation.

18. The cartridge ofclaim 17, wherein the first surgical fasteners include first legs extending from the first backspan and terminating in penetrating ends and the second surgical fasteners include second legs extending from the second backspan and terminating in penetrating ends, wherein the first backspan includes at least one portion curving inwardly toward the penetrating ends of the first legs to form a humped configuration to define the first height, and the second backspan includes at least one portion curving inwardly toward the penetrating ends of the second legs to form a humped configuration to define the second height.

19. The cartridge ofclaim 17, wherein the cartridge includes a central longitudinal axis and the second fastener row is disposed further from the central longitudinal axis than the first fasteners.

20. The cartridge ofclaim 19, further comprising a plurality of third surgical fasteners having a third backspan with a third configuration such that the plurality of third surgical fasteners apply a third compressive force to the tissue upon formation that is different from at least one of the first compressive force and the second compressive force respectively applied to the tissue by the plurality of first surgical fasteners and the plurality of second surgical fasteners upon formation, the third fasteners being disposed further from the central longitudinal axis than the second fasteners.

21. The cartridge ofclaim 17, wherein the first backspan of the first surgical fasteners and the second backspan of the second surgical fasteners are dimensioned such that the first compressive force is greater than the second compressive force.

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